title: Successful treatment of thromboangiitis obliterans (Buerger's disease) with immunoadsorption: results of a pilot study.
abstract: BACKGROUND
  No established therapy is available for patients with thromboangiitis obliterans (TAO) and critical limb ischemia. Since abnormalities of the immune system appear to be involved in the pathogenesis, we investigated in this pilot study the efficiency of Ig immunoadsorption (IA) therapy.
  
  
  METHODS
  Ten patients with advanced TAO underwent a single IA course over five consecutive days. Before IA angiography was performed. In addition, the following were conducted prior to IA, directly after, as well as 1, 3, and 6 months after IA: clinical examination, pain scale (0-10), treadmill test for evaluation of maximum walking distances, and several angiological methods for evaluation of disease extent: photoplethysmography, ultrasound Doppler, and transcutaneous assessment of partial carbon dioxide (tcPCO(2)) and oxygen (tcPCO(2)) pressure.
  
  
  RESULTS
  Immunoadsorption treatment was tolerated without side effects. Pain intensity decreased rapidly from 7.7 ± 0.8 (mean ± SEM) before treatment to 2.0 ± 1.2 at the second day of IA. One month after IA, all patients were without pain. This functional amelioration persisted over the follow-up period of 6 months. Correspondingly, maximum walking distances significantly increased from 301.7 ± 191.4 to 727.0 ± 192.7 m immediately after IA, and further continuously up to 1,811.0 ± 223.7 at 6 months after IA. Healing of ischemic ulcerations was observed in all patients during follow-up. (tcPCO(2)) and (tcPCO(2)) values as well as photopletysmographic data that were severely compromised before IA reflecting reduced tissue oxygenation and perfusion showed rapid amelioration reaching normal values at 1 month.
  
  
  CONCLUSIONS
  Anti-Ig IA appears to be an effective therapeutic option for patients with advanced TAO.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie Charité, Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany. gert.baumann@charite.de
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Verena
authors.initials: V
authors.lastname: Stangl
authors.forename: Peter
authors.initials: P
authors.lastname: Klein-Weigel
authors.forename: Karl
authors.initials: K
authors.lastname: Stangl
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
authors.forename: Kathrin
authors.initials: K
authors.lastname: Enke-Melzer
mesh_terms: D000328:Adult; D000792:Angiography; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013919:Thromboangiitis Obliterans / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000888:Antibodies, Anti-Idiotypic